Provider Demographics
NPI:1659300481
Name:CHAGNON, JEAN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:CHAGNON
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 WOODLANE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3910
Mailing Address - Country:US
Mailing Address - Phone:651-739-7539
Mailing Address - Fax:651-730-9200
Practice Address - Street 1:1789 WOODLANE DR
Practice Address - Street 2:SUITE C
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3910
Practice Address - Country:US
Practice Address - Phone:651-739-7539
Practice Address - Fax:651-730-9200
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3414103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling